Provider Demographics
NPI:1447530811
Name:MATHEW, RACHEL (APRN-CNP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:MATHEW
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:RACHALAMMA
Other - Middle Name:
Other - Last Name:JACOB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-CNP
Mailing Address - Street 1:1923 S UTICA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-6520
Mailing Address - Country:US
Mailing Address - Phone:918-748-7650
Mailing Address - Fax:918-403-6341
Practice Address - Street 1:1923 S UTICA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-6520
Practice Address - Country:US
Practice Address - Phone:918-748-7650
Practice Address - Fax:918-403-6341
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK78436363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200399480AMedicaid